Cancer

Question 1

Since chemo drugs target rapidly growing cells, which ones are going to be affected in addition to cancer cells?

Answer 1

Bone marrow- WBCs, RBCs, platelets

GI tract- N/V, diarrhea, dysphagia

Hair

Renal-increased uric acid from destruction of cells can cause damage

Fetuses

Spermatogenesis

Question 2

What are the 3 drugs that are alkylating drugs?

Answer 2

Cyclophosphamide

Mechlorethamine

Carmustine

Question 3

Which types of drugs are not specific to cell cycle?

Answer 3

Alkyltaing agents

Platinum analogs

Antibiotic-doxorubicin

(As long as the cell is dividing, these will work)

Question 4

What is the MOA of alkylating agents?

Answer 4

They alkylate the DNA and cause miscoding, breakage, and crosslinking

Question 5

What kinds of cells do alkylating agents have the most effect on?

Answer 5

Rapidly proliferating cells- tumor cells, but also GI, hair, and bone marrow

Question 6

What is a shared toxicity of all the alkylating agents?

Answer 6

Vesication- tissue damage at injection site

Question 7

What two things do we have to do if we give our patient cyclophosphamide?

Answer 7

Give MESNA and aggressively hydrate

Question 8

Why do we have to give MESNA and aggressively hydrate when we give our patients the alkylating agent cyclophosphamide?

Answer 8

It gets metabolized down into acrolein which causes hemorrhagic cystitis

Question 9

What can we give our patient who is taking mechlorethamine to prevent kidney damage?

Answer 9

Allopurinol, since mechlorethamine can cause hyperuricemia due to cell breakdown

Question 10

Which alkylating agent crosses the blood-brain barrier and would be useful for brain cancer?

Answer 10

Carmustine

Question 11

What is the MOA of cisplatin?

Answer 11

Cross links DNA and causes it to break

Question 12

What are the 2 main side efffects of cisplatin

Answer 12

kidney damage

Hearing loss

Question 13

What should we give with cisplatin?

Answer 13

Give with amifostine to reduce kidney damage

Question 14

What is the MOA of doxorubicin (the antibiotic)

Answer 14

Intercalates into DNA and destroys DNA

Question 15

What is the main side effect of doxorubicin?

Answer 15

Cardiotoxicity

Question 16

What makes the side effect of doxorubicin worse?

Answer 16

Iron

Question 17

What do you have to give with doxorubicin to decrease its side effect?

Answer 17

Give dexrazoxane becasue it chelates iron and reduces the cardiotoxicity

Question 18

What are the types of cell-cycle specific drugs?

Answer 18

Antimetabolites (S-phase)

Mitosis inhibitors (M-phase)

Antibiotic-bleomycin (G2-M phase)

Question 19

What are the antimetabolites?

Answer 19

Methotrexate

6-mercaptopurine

5-fluorouracil

Question 20

What is the MOA of methotrexate?

Answer 20

Inhibits dihydrofolate reductase

Question 21

What do you need to give AFTER methotrexate?

Answer 21

Leucovorin

Question 22

What do you need to give AFTER 6-mercaptopurine?

Answer 22

Leucovorin

Question 23

What do you need to give BEFORE 5-Fluorouracil and why?

Answer 23

Leucovorin to enhance the binding to thymidylate synthase and increase its activity

Question 24

What two drugs should you NOT combine with allopurinol?

Answer 24

Azathioprine

6-mercaptopurin

Both drugs get metabolized by xanthine oxidase and allopurinol inhibits XO.
POTENTIALLY FATAL BLOOD DISCRASIAS

Question 25

Why cant you give allopurinol with 6-mercaptopurin or azathioprine?

Answer 25

Both drugs get metabolized by xanthine oxidase and allopurinol inhibits XO.
POTENTIALLY FATAL BLOOD DISCRASIAS

Question 26

What cell cycle does bleomycin target?

Answer 26

G2 and M

Question 27

What is one of the benefits of bleomycin?

Answer 27

Very little immunosuppression

Question 28

What are the drugs in the mitosis inhibitors class?

Answer 28

Vincristine

Vinblastine

Paclitaxel

Question 29

What is the MOA of vincristine and vinblastine?

Answer 29

They inhibit polymerization of the microtubule. Cell cycle is stopped in metaphase

Question 30

What is the MOA of paclitaxel?

Answer 30

Inhibits depolymerization of the microtubules, so they are way too stable and non-functional

Question 31

What are the side effects of vincristine and vinblastine?

Answer 31

They both have neurotoxicity and myelosuppression, BUT:

Vincristine has more neurotoxicity

Vinblastine has more myelosuppression

Question 32

What is the side effect paclitaxel?

Answer 32

Severe myelosuppression

Question 33

What does imatinib (gleevec) inhibit?

Answer 33

the Bcr-Abl fusion tyrosine kinase

Question 34

Should you do any testing before starting your patient on Imatinib (gleevec)?

Answer 34

Yes, it only works on the Bcr-Able tyrosine kinase, so if they don’t have that translocation, it’s not going to work

Question 35

What class is imatinib (Gleevec) in?

Answer 35

Tyrosine kinase inhibitors

Question 36

What drugs are in the growth-factor receptor inhibitors class?

Answer 36

Cetuximab

Erlotinib

Bevacizumab

Question 37

Should you do any testing before starting cetuximab or erlotinib?

Answer 37

Yes, you need to test for epidermal growth factor receptor (EGFR) expression and mutations, otherwise they wont work

Question 38

What are the main side effects of imatinib(gleevec)

Answer 38

Fluid retention causing ankle edema and periorbital edema- may need to take diuretics

Question 39

What is the MOA of bevacizumab, and what is the result of that?

Answer 39

It binds to VEGF and prevents binding to that receptor. This prevents angiogenesis

Question 40

What are the main side effects of bevacizumab?

Answer 40

Bleeding

Thromboembolism